Rising expectations of clients

RE: Rising expectations of clients

Gillian Mostyn — Sat, 21 Apr 2018 21:03:57 GMT

[quote user="Anthony Todd"]That does surprise me. [/quote]

He might go back to it...but no idea at the moment. He is enjoying being a house husband too much!! And I'm quite happy having my dinner ready every night when I get home from work.

RE: Rising expectations of clients

Anthony Todd — Sat, 21 Apr 2018 16:10:51 GMT

[quote user="Gillian Mostyn"]who stopped being a vet 2 months ago at age 42. [/quote]

That does surprise me. I still miss practicing at 79..... which I suppose is why I still bear the slings and arrows I continually get on here.

I'm driving my wife mad by being at home all the time and "running" the household instead of the practices.....

RE: Rising expectations of clients

Gillian Mostyn — Sat, 21 Apr 2018 13:50:13 GMT

Anthony..the problem isn't the 60+ year olds leaving...they'd be retiring anyway. The problem is the 40 year olds leaving. Like my husband, who stopped being a vet 2 months ago at age 42. I am still working, but I seriously considered stopping too. Fortunately I am enjoying my new role, with much less management. And being less stressed means I am much more able to deal with the difficult situations and clients. I didn't realise how emotionally exhausted I was until it stopped.....

RE: Rising expectations of clients

Anthony Todd — Sat, 21 Apr 2018 12:29:29 GMT

[quote user="David Catlow"]= 4000+ experienced vets who have left partnership in the last few years. [/quote]

I believed, from the copious comments on here, that they were all geriatric dinovets, way behind the times, who used corticosteroids or euthanasia for everything and "diagnosis" was something they'd only just read about ??

RE: Rising expectations of clients

David Catlow — Thu, 19 Apr 2018 18:38:06 GMT

[quote user="Arlo Guthrie"]Are there any figures on how many people have retired early as a result of corporate buyouts? I'm wondering how many stayed on after they were bought, vs how many said 'whoopeee', and headed off to the Caribbean?[/quote]

I think those figures will be known only by the larger corporate practices themselves. Is it reasonable to estimate approximately 2000 practices purchased so far? average 2 partners, possibly more, per practice. = 4000+ experienced vets who have left partnership in the last few years. what % of those are still working after selling? Some partners may have left immediately and others may have clauses to remain for a minimum length of service or wish to stay longer. For the more recent practice purchases (and it seems to have been accelerating in the last 24 months) there will presumably be a lag, and therefore potentially an increasing number of people leaving the profession still to come?

RE: Rising expectations of clients

bevs2251 — Thu, 19 Apr 2018 06:17:18 GMT

[[quote user="Julie Innes"]

I had a woman scream at a colleague " I don't care if the kid's bloody rabbit is dead! I've waited 15 minutes for my dogs vaccination! "

I wonder if people are genuinely more insular and disconnected today.

[/quote] Swearing and screaming is unacceptable, even if it is the minor expletive "bloody". Anyone that swears at me is immediately shown the door - complete disrespect. If they then start shouting "I'll report you to the board", I calmly tell them to go right ahead as I haven't done anything wrong. The bully types like these usually back down and sheepishly exit the building. Don't care about their mental state - people need to learn to control themselves.

Waited at he bank just then for 15 minutes to be seen to apply for a home loan top-up. Had to leave as only 30 minute lunch break. Didn't go screaming and carrying on like a pork chop because they were unable to attend to my enquiry then and there - politely advised I couldn't wait any longer and would follow up by phone.

I think rudeness and unacceptable behaviour should be confronted. If you lose this client, did you want them in the first place ?

I invariably wait at least 20 minutes to see my GP, regardless of the appointment time - NEVER on time (actually factor that in to my day ).

RE: Rising expectations of clients

David Catlow — Thu, 19 Apr 2018 05:33:50 GMT

written permission for every injection and prescription I agree would be ludicrous, but I don't think the regulator has said that. The world would grind to a halt

Guidance notes to the Code are there to help vets know what informed consent looks like and make a judgement for every unique circumstance. they are not rules. The significant advice around informed consent reflects the relatively high number of complaints that are received by the College due to owners claiming that they did not understand or were not informed. Written consent provides clear evidence that they were, hence the guidance.

I am currently involved in a complaint in practice where the owner was in the room actually holding the dog for a minor procedure and they are now stating that they didn't give informed consent. Life can be very difficult sometimes.

RE: Rising expectations of clients

Anthony Todd — Wed, 18 Apr 2018 14:51:38 GMT

[quote user="Bob Russell"]Perhaps it should be VDS that tells us what needs to be on the form to give us maximum protection! [/quote]

I can't help feeling that getting clients to sign anything around "consent" is a sort of "all care but no responsibility" sign on the wall of dodgy motor repairers.

The more comprehensive and inclusive the more the clients will feel the same.

Are we sure a simple, oral "Are you happy with what I have said and with what I advise?" is not enough. Recorded in the notes if you like??

Anaesthetic consent forms are about as far as I feel we should go.

Is this particular all enveloping consent a problem area?

Have there been cases revolving around a lack of this "consent"?

RE: Rising expectations of clients

Bob Russell — Wed, 18 Apr 2018 13:36:44 GMT

How do we decide what 'informed' actually means. It varies between clinets.

The longer and more complex the consent form becomes, the less likely most owners are to read it let alone understand it! Owners range from the barely educated to the best brains on earth.

Someone at the RCVS deciding what must be included is hardly helpful or constructive. Perhaps it should be VDS that tells us what needs to be on the form to give us maximum protection!

RE: Rising expectations of clients

Anthony Todd — Wed, 18 Apr 2018 13:20:24 GMT

Or you could just adopt the approach used by an American vet when asked by a very switched on university lab tech of my acquaintance:

Lab Tech, as vet was giving her cat an injection; "What's that?"

Vet "It's med-i-cine"

Lab tech; "yes, but what for?"

Vet; "to make your cat better"

RE: Rising expectations of clients

George Cooper — Wed, 18 Apr 2018 09:25:16 GMT

"Informed Consent" is implicit in the fact that the client has consulted us. Full stop.

And to take this to stupid levels, following the insane weight thrust upon it by our out-of-touch regulator - we should be getting written permission giving this "Informed Consent" for every injection, prescription, whatever. Illogical conclusion. What makes any decision different to every other decision?

RE: Rising expectations of clients

Liz Barton — Tue, 17 Apr 2018 21:18:32 GMT

[quote user="David Catlow"]I don't see 'informed consent' as a box ticking exercise to protect myself and satisfy RCVS. It is a normal part of good communication with a client. [/quote]

Informed consent for procedures is wholly valuable and appropriate, BUT for some people being informed means a detailed discussion justifying every decision, and a risk / benefit analysis for the minutiae.

E.g. prescribing a course of meds for skin disease and a client expecting an in depth discussion of every possible adverse reaction to each med, and the likelihood thereof. It's just not feasible.

RE: Rising expectations of clients

David Mills — Tue, 17 Apr 2018 19:17:28 GMT

[quote user="Julie Innes"]

I was thinking about this thread this morning when I heard on the radio that attacks on NHS workers had increased by 10% in the last year. I know a lot of people on here are trying to say that society hasn't changed, it's just that we are wusses nowadays, but I think this shows that it has, and we should get our heads around that.

[/quote]

10 per cent means very little without the absolute figures. This is tabloid posturing. At the very least it would need to be contextualised by what they are measuring, and the trend over the last 5-10 years.

It is proof of.nothing but lazy reporting.

Who knows whether society is changing? People haven't suddenly become different, although may have more avenues to express themselves. Maybe they now have a need to have instant reactions, maybe they are less polite, maybe we are more sensitive.

Sitting here and blaming people for changing is self serving and navel gazing. There are things that people can do to alter the dynamic.

RE: Rising expectations of clients

George Cooper — Tue, 17 Apr 2018 13:44:47 GMT

[quote user="Arlo Guthrie"]

[quote user="David Catlow"]you've captured the landscape perfectly Arlo, but it's not changed overnight. wghat has happened overnight is the numbers of more experienced vets leaving the profession as a result of a financial opportunity.[/quote]

Thanks David Catlow! Are there any figures on how many people have retired early as a result of corporate buyouts? I'm wondering how many stayed on after they were bought, vs how many said 'whoopeee', and headed off the to Caribbean?

[quote user="George Cooper"]“but the key issue is that society, information and expectation have changed considerably, and the importance of good communication skills with everyone around you has never been greater”

That quote from David C...... I am going to disagree pretty strongly with the assertion that expectation has changed considerably. Our clients want what they have ALWAYS wanted - that we as vets will accept the responsibility for the healthcare of the pet or animal presented to us and that we will restore it to health as it was - or else explain why another outcome with happen.[/quote]

Gotta say, I'm with David on this - I think people's expectations (or 'sense of entitlement to') have increased in recent decades. Partly the consequence of the increased welfare state, partly because of unrealistic media portrayals, and partly because of things like facebook, where, unmoderated, people post all kinds of stuff that raises unrealistic expectations.

[/quote]

Of course what a client "wants" is coloured by what they seem to see and hear on the telly and in the Mail. It is then up to us to deal with that, as many of us do, in a calm and assertive, persuasive manner, explaining the reality of veterinary life vis-s-vis their pet and its health which they have passed over to us to assume responsibility for.

We really aren't on different sheets of the hymnary y'know!

RE: Rising expectations of clients

George Cooper — Tue, 17 Apr 2018 13:41:24 GMT

[quote user="David Catlow"]

[quote user="George Cooper"]

this is simplicity itself, and it is how we address this that affects how we are seen in the eyes of clientele. Inte4minable “informed consent” discussions where a client cannot hope to assimilate the situation that we and we alone are trained to assess merely increases their, and our hassle levels. The fear of RCVS who are hell bent (or were in the Stace years) on kow-towing to so called “the Public” desires, when we and we alone are in the driving seat of any consultation, and able to deal with any and all “ objections”, problems, whatever that clients raise either realistically or cussedly. THAT IS OUR OBLIGATION on the route to animal health and welfare. And we must accept it and deal with it.

[/quote]

I do think that the public does have very high expectation of medical and veterinary intervention now. Set by our medical colleagues and the incredible ways we can now be kept alive for longer as well as tv vet shows and wider information and media. I certainly have a much higher expectation than I did 30 years ago. In veterinary, there is also an unrealistic expectation of associated costs too.

However expectation and reality then have to be joined up in the consulting room by good communication.

'informed consent' seems to be the phrase that ties people in knots. For me I look at it as 'what would I want to know before i agreed to have something done to my pet, or even my child?' yes I do want to know what could wrong, not everything, and how much its likely to cost, because Id be pretty cheesed off if something happened that I should have known was possible beforehand. and I certainly want to know if it was going to cost £200 or £2000. Don't let someone assume its £200 then land them with a £2k bill after the event and expect them to be happy. much rather tell them its going to be £2k beforehand and give them the good news that its only £1500 afterwards... thats the way to avoid complaints

Its not unreasonable to want my expectation joined up with reality.

I don't see 'informed consent' as a box ticking exercise to protect myself and satisfy RCVS. It is a normal part of good communication with a client.

the RVC research last year on client perceptions of informed consent made interesting reading. clients perceived it as signing away their rights. If that's the way its perceived then we are probably communicating it badly and need to rethink. But then the legal profession put their stamp into the equation and unless its written down and signed for then it all becomes a much murkier world when theres a dispute. Its funny how some people can have a very different interpretation of what was said after the event when things have gone wrong!

[/quote]

David - I agree completely with your assessment of "informed consent" - because it is exactly what we do day in day out, and yet the RCVS has hammered it into a blunt instrument for bludgeoning us all into interminable bits of ruddy paper, as if somehow we cannot be trusted to use common sense.

RE: Rising expectations of clients

Julie Innes — Tue, 17 Apr 2018 11:33:55 GMT

RE: Rising expectations of clients

Arlo Guthrie — Tue, 17 Apr 2018 10:23:12 GMT

RE: Rising expectations of clients

David Catlow — Mon, 16 Apr 2018 21:23:44 GMT

[quote user="George Cooper"]

[/quote]

However expectation and reality then have to be joined up in the consulting room by good communication.

Its not unreasonable to want my expectation joined up with reality.

I don't see 'informed consent' as a box ticking exercise to protect myself and satisfy RCVS. It is a normal part of good communication with a client.

RE: Rising expectations of clients

George Cooper — Mon, 16 Apr 2018 16:37:41 GMT

“but the key issue is that society, information and expectation have changed considerably, and the importance of good communication skills with everyone around you has never been greater”

RE: Rising expectations of clients

David Catlow — Mon, 16 Apr 2018 16:24:05 GMT

[quote user="Arlo Guthrie"]

I was going to reply to this the other day, got distracted, then others wrote sort of what I was thinking.

Moderating these forums, I guess I get a particular view of things which, whilst it may represent what a lot of people here think, may not be representative of the wider profession.

Still ...

I ask myself whether it is stretching things to say that the profession is suffering a crisis in confidence caused by:

Increasingly informed clients (Dr Google) questioning everything in a way that didn't happen in the past (actually, questioning things is fine, it's arguing I really mean).
The less polite world we live in today (am I imagining that, or is it just something older people always say?)
The ability that clients have to complain publicly, very publicly (facebook et al)
The increasingly litigious, 'elf 'n safety world we live in. Or rather, the fear of it.

not helped by ...

the sort of person a veterinary surgeon is or becomes (are vets inherently self-doubting, I ask myself, ie because its a job where there is never one right answer, so you are often left asking yourself whether you picked the right one).

aided and abetted by

the regulator seeming to be too far on the side of the consumer (I think of Mr Stace being a consumer champion).
the potentially catastrophic consequences of complaint to the RCVS, the time it takes to process, and possibly the fact that when you get exonerated it often also comes with 'advice' about how you could do better (ie 'you weren't wrong, but you were').
A couple of people have mentioned: something about the language/tone which the RCVS might be using.

[/quote]

you've captured the landscape perfectly Arlo, but it's not changed overnight. wghat has happened overnight is the numbers of more experienced vets leaving the profession as a result of a financial opportunity. this is leading to a shortage of vets and more pressure on those left behind with changed career earning potential and / or aspirations.

the blame is being pointed at the industry leaders, although in my view, the strategic planning behind the corporate acquisition business models should have foreseen the inevitable trends that would develop. presumably the same happened in the optical world when consolidation hit their industry, and its certainly hit the teaching and medical professions when retirement packages were changed, which led to larger numbers taking the opportunity to retire early.

yes RCVS needs to handle complaints more quickly and sensitively; yes VCMS will help direct a % of complaints to more appropriate channels; yes its distressing when knowing a complaint has been made against you. I know from first hand experience! and yes, you need a peer group of support around you when that happens to give support.

we also need an industry that doesn't peddle fear into new grads, such as 'you'll be struck off if you don't refer to a specialist if you've never seen it before' and other RCVS will get you if... scenarios.

but the key issue is that society, information and expectation have changed considerably, and the importance of good communication skills with everyone around you has never been greater

RE: Rising expectations of clients

Niall Taylor — Mon, 16 Apr 2018 15:51:54 GMT

[quote user="Arlo Guthrie"]So pity the new grad employee who's had a complaint against them. That must be the pits.[/quote]

But it can be made better with the support of that 'older, male, practice-owner type' you mentioned (regardless of the actual sex of the OMPOT). Is it the case then that younger and/or more vulnerable members of the profession aren't getting such support from the OMPOTs in the same practice; is this to do with corporates where such senior support might not even be available?

I have never, ever let any younger colleagues deal with an RCVS complaint (or even the majority of somple client complaints) on their own - I've taken them through it, explained what to do, liased with VDS, the client and RCVS on their behalf and reassured them about what to expect. Touch wood, by and large things haven't been too bad, and we've had some stinkers, complaint-wise.

Maybe we've just been lucky.

Niall

RE: Rising expectations of clients

Arlo Guthrie — Mon, 16 Apr 2018 14:22:11 GMT

Oh, and I know stating the obvious, but was also going to add that a crisis in confidence is more likely to affect

New grads
Employees (who don't feel they have the authority to tell a client to pull their socks up)
Female? (before anyone screams sexist, I just mean perhaps less likely to feel comfortable being combative).
Probably anyone who has been on the receiving end of a complaint, or seen others going through the process

... than the older, male, practice-owner type.

So pity the new grad employee who's had a complaint against them. That must be the pits.

RE: Rising expectations of clients

Francisco Gomez — Mon, 16 Apr 2018 13:53:54 GMT

[quote user="George Cooper"]

Somebody, cannot recall who, asked in this thread for "help" from BVA, RCVS, et al in somehow dealing with this apparent phenomenon.

How, I ask, can any "pontification", pacification, education from such organisations actually be of ANY benefit

[/quote]

Me.

I feel the new challenges the profession faces ie Facebook and Google diagnosis and complain aids must be dealt with new powers. That's my position at least.

Many surgeries operate a 'client responsibility' chart. I wonder if the bodies who aid and regulate us should combine to create an universal chart and for this to be embedded in our Code.

I understand that if this was to be abused, an animal could be suffering as a consequence. But on the other hand, many other animals will suffer, as direct effect or a knock on from unhelpful clients if the situation progresses.

Is it right that you often neglect the premium care of a good, polite and paying client because you're dealing for far too long with the obnoxious, demanding and threatening one?

RE: Rising expectations of clients

Julie Innes — Mon, 16 Apr 2018 13:49:59 GMT

I think the clients that wind us up are the ones that stay in our minds and niggle. Sadly, the grateful and appreciative clients don't take up so much of our headspace.

as I said on my other thread about the incontinent dog, the owners really appreciated the time I took to look into it, and the fact I followed up with a phone call (even if they don't want my advice ) that they bought me wine and chocolate. But I don't think about that at 3am!

RE: Rising expectations of clients

George Cooper — Mon, 16 Apr 2018 13:05:42 GMT

Following on from Arlo’s erudite summary, which I think does contain some superb observations, I am moved to say that - generalising, of course - vets do tend to take things personally, and if a client questions something, a defensive attitude can be the result. And if a client doesn’t accept our advice and act upon it to the letter, it is seen as a personal slight.

RCVS, consumerism, language employed all conspire to increase the need to avoid that particular set of circumstances where a “concern” (effing stupid description) becomes a possibility. Avoidance - be that of client, or of making a decision (think ‘informed consent’, another misdirected concept given far too much weight post Stace), or starting treatment (think endless tests.....), all leading to increased anxiety for self existing in this big bad world, where we can do nothing about the rcvs, but we CAN whinge about bastard clients.